MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

Background Predictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assess...

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Bibliographic Details
Published in:Digestive diseases and sciences 2023-03, Vol.68 (3), p.1042-1050
Main Authors: Horvatits, Thomas, Mahmud, Nadim, Serper, Marina, Seiz, Oliver, Reher, Dominik, Drolz, Andreas, Sarnast, Naveed, Gu, Wenyi, Erasmus, Hans Peter, Allo, Gabriel, Ferstl, Phillip, Wittmann, Sebastian, Piecha, Felix, Groth, Stefan, Zeuzem, Stefan, Schramm, Christoph, Huber, Samuel, Rösch, Thomas, Lohse, Ansgar W., Trebicka, Jonel, Ogola, Gerald, Asrani, Sumeet K., Kluwe, Johannes
Format: Article
Language:English
Subjects:
Biochemistry
Comparative analysis
End Stage Liver Disease - complications
Esophageal and Gastric Varices - complications
Esophageal and Gastric Varices - etiology
Gastroenterology
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Glycosylated hemoglobin
Health aspects
Hemoglobin
Hepatology
Hospitals
Humans
Lactates
Lactic Acid
Liver
Liver Cirrhosis
Liver diseases
Medical colleges
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Mortality
Oncology
Original Article
Prognosis
Retrospective Studies
Severity of Illness Index
Transplant Surgery
Veterans
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Summary:Background Predictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assessed in the context of variceal bleeding. Aims We aimed to evaluate the predictive performance of MELD-LA compared to MELD, lactate, and nadir hemoglobin in cirrhosis patients with variceal bleeding. Methods In this multicenter study, we identified 472 patients with variceal bleeding from a German primary cohort (University Hospitals Hamburg/Frankfurt/Cologne), and two independent external validation cohorts [Veterans Affairs (VA), Baylor University]. Discrimination for 30-day mortality was analyzed and scores were compared. MELD-LA was evaluated separately in validation cohorts to ensure consistency of findings. Results In contrast to nadir hemoglobin, MELD and peak-lactate at time of bleeding were significantly higher in 30-day non-survivors in the primary cohort ( p  = 0.708; p  
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-022-07744-w